Ultrasound-guided continuous infraclavicular brachial plexus block using bupivacaine alone or combined with adenosine for pain control in upper limb surgery

Abstract

Introduction:The infraclavicular brachial plexus block (ICB) is designed to deposit anesthetic high in the plexus, achieving anesthesia of the hand, forearm, elbow, and distal arm. Adenosine is a metabolic intermediate that is involved in nearly all aspects of cell function, including neurotransmission and signal transduction.This study was aimed to show whether addition of adenosine to bupivacaine in ultrasound-guided ICB had an analgesic effect.Methods:Sixty adult patients were divided into two equal groups, each group included 30 patients. Group I received infraclavicular bupivacaine 0.325% in a volume of 30 ml. Group II received 30 ml of 0.325% bupivacaine + 12 mg adenosine. The block was maintained with an infusion of 10 ml/h. The following parameters were assessed: Success rate, time of the sensory onset, motor block, visual analog scale (VAS), and amount of i.v. pethidine needed.Results:This study showed an analgesic effect of infraclavicular adenosine as evidenced by a statistically significant shorter mean time of onset of the sensory block (16 vs. 20 min, P < 0.05), lower mean VAS score over 48 h (1.7 vs. 2.7, P < 0.05), longer mean time of first parenteral analgesic requirement (299 vs. 255 min, P < 0.05), and lower mean total dose of pethidine needed over 48 h after surgery (25.5 vs. 56.6 mg, P <0.05). All patients got successful infraclavicular block and recovered uneventfully without any sensory or motor deficit.Conclusion:Adenosine may provide valuable addition to the therapeutic options in anesthesia and pain management. Further research is required to figure out its exact role

Adenosine or Magnesium Sulphate as Adjuvants for Pectoral Nerves Block in Modified Radical Mastectomy: A Randomized Controlled Trial

“…The authors found advantages of using adenosine regarding the duration of the block and the consumption of post-operative analgesics. mended more studies to evaluate adenosine role in local nerve blocks [25]. The present study agrees with Mahmoud and Ammar.…”

“…Vey few authors investigated the role of adenosine as an adjuvant to local anaesthetics. Mahmoud and Ammar used adenosine in brachial plexus block [25].…”

A dose-finding randomised controlled trial of magnesium sulphate as an adjuvant in ultrasound-guided supraclavicular brachial plexus block

“…A variety of perineural adjuvants[2345] have been tried to hasten the time of onset and prolong the duration of analgesia of nerve blocks with varying degrees of success. Better knowledge of pain mechanisms has highlighted the role of central sensitisation and N-methyl-D-aspartate (NMDA) receptors in post-surgical pain.…”

Training in ultrasound guided blocks

“…In this issue of SJA three articles appeared pertaining to the practice in anesthesiology of regional techniques in both adult and pediatric patients. [ 4 – 6 ] We believe that workshops and simulations will play a major role in the training of competent practitioners in ultrasound regional blocks.…”